Matthew G Parry1, Arunan Sujenthiran2, Thomas E Cowling3, Susan Charman4, Julie Nossiter5, Ajay Aggarwal6, Noel W Clarke7, Heather Payne8, Jan van der Meulen9. 1. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom. Electronic address: mparry@rcseng.ac.uk. 2. Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom. Electronic address: ASujenthiran@rcseng.ac.uk. 3. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom. Electronic address: Thomas.Cowling@lshtm.ac.uk. 4. Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom. Electronic address: susan.charman@cysticfibrosis.org.uk. 5. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom. Electronic address: jnossiter@rcseng.ac.uk. 6. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, England, United Kingdom; Department of Cancer Epidemiology, Population, and Global Health, King's College London, Strand, London, WC2R 2LS, England, United Kingdom. Electronic address: Ajay.Aggarwal@lshtm.ac.uk. 7. Department of Urology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, England, United Kingdom; Department of Urology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, England, United Kingdom. Electronic address: Noel.Clarke@srft.nhs.uk. 8. Department of Oncology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, England, United Kingdom. Electronic address: heather_payne@blueyonder.co.uk. 9. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom. Electronic address: Jan.vanderMeulen@lshtm.ac.uk.
Abstract
BACKGROUND: Cancer stage can be missing in national cancer registry records. We explored whether missing prostate cancer stage can be imputed using specific clinical assumptions. METHODS: Prostate cancer patients diagnosed between 2010 and 2013 were identified in English cancer registry data and linked to administrative hospital and mortality data (n = 139,807). Missing staging items were imputed based on specific assumptions: men with recorded N-stage but missing M-stage have no distant metastases (M0); low/intermediate-risk men with missing N- and/or M-stage have no nodal disease (N0) or metastases; and high-risk men with missing M-stage have no metastases. We tested these clinical assumptions by comparing 4-year survival in men with the same recorded and imputed cancer stage. Multi-variable Cox regression was used to test the validity of the clinical assumptions and multiple imputation. RESULTS: Survival was similar for men with recorded N-stage but missing M-stage and corresponding men with M0 (89.5% vs 89.6%); for low/intermediate-risk men with missing M-stage and corresponding men with M0 (92.0% vs 93.1%); and for low/intermediate-risk men with missing N-stage and corresponding men with N0 (90.9% vs 93.7%). However, survival was different for high-risk men with missing M-stage and corresponding men with M0. Imputation based on clinical imputation performs as well as statistical multiple imputation. CONCLUSION: Specific clinical assumptions can be used to impute missing information on nodal involvement and distant metastases in some patients with prostate cancer.
BACKGROUND:Cancer stage can be missing in national cancer registry records. We explored whether missing prostate cancer stage can be imputed using specific clinical assumptions. METHODS:Prostate cancerpatients diagnosed between 2010 and 2013 were identified in English cancer registry data and linked to administrative hospital and mortality data (n = 139,807). Missing staging items were imputed based on specific assumptions: men with recorded N-stage but missing M-stage have no distant metastases (M0); low/intermediate-risk men with missing N- and/or M-stage have no nodal disease (N0) or metastases; and high-risk men with missing M-stage have no metastases. We tested these clinical assumptions by comparing 4-year survival in men with the same recorded and imputed cancer stage. Multi-variable Cox regression was used to test the validity of the clinical assumptions and multiple imputation. RESULTS: Survival was similar for men with recorded N-stage but missing M-stage and corresponding men with M0 (89.5% vs 89.6%); for low/intermediate-risk men with missing M-stage and corresponding men with M0 (92.0% vs 93.1%); and for low/intermediate-risk men with missing N-stage and corresponding men with N0 (90.9% vs 93.7%). However, survival was different for high-risk men with missing M-stage and corresponding men with M0. Imputation based on clinical imputation performs as well as statistical multiple imputation. CONCLUSION: Specific clinical assumptions can be used to impute missing information on nodal involvement and distant metastases in some patients with prostate cancer.
Authors: M G Parry; T E Cowling; A Sujenthiran; J Nossiter; B Berry; P Cathcart; A Aggarwal; H Payne; J van der Meulen; N W Clarke; V J Gnanapragasam Journal: BMC Med Date: 2020-05-28 Impact factor: 8.775